Ethnic differences in participation in prenatal screening for Down syndrome: A register‐based study

BackgroundTwo prenatal screening tests for congenital anomalies are offered to all pregnant women in the Netherlands on an opt-in basis: the Combined Test (CT) for Down syndrome at twelve weeks, and the Fetal Anomaly Scan (FAS) at around twenty weeks. The CT is free for women who are 36 or older; the FAS is free for all women. We investigated factors associated with the CT and FAS uptake.MethodThis study is part of the DELIVER study that evaluated primary care midwifery in the Netherlands. Associations between the women’s characteristics and the CT and FAS uptake were measured using multivariate and multilevel logistic regression analyses.ResultsOf 5216 participants, 23% had the CT and 90% had the FAS, with uptake rates ranging from 4% to 48% and 62% to 98% respectively between practices. Age (OR: 2.71), income (OR: 1.38), ethnicity (OR: 1.37), being Protestant (OR: 0.25), multiparous (OR: 0.64) and living in the east of the country (OR: 0.31) were associated with CT uptake; education (OR: 1.26), income (OR: 1.66), being Protestant (OR: 0.37) or Muslim (OR: 0.31) and being multiparous (OR: 0.74) were associated with FAS uptake. Among western women with a non-Dutch background, first generation (OR: 2.91), age (OR: 2.00), income (OR: 1.97), being Protestant (OR: 0.32) and living in the east (OR: 0.44) were associated with CT uptake; being Catholic (OR: 0.27), Protestant (OR: 0.13) were associated with FAS uptake. Among non- western women with a non-Dutch background, age (OR: 1.73), income (OR: 1.97) and lacking proficiency in Dutch (OR: 2.18) were associated with CT uptake; higher education (OR: 1.47), being Muslim (OR: 0.37) and first generation (OR: 0.27) were associated with FAS uptake.ConclusionThe uptake of the CT and FAS varied widely between practices. Income, parity and being Protestant were associated with uptake of both tests; ethnicity, age and living in the east were associated with CT uptake, and education and being Muslim with FAS uptake. These findings help to explain some differences between women choosing or declining early and late screening, but not the large variation in test uptake among practices, nor between the Netherlands and other countries.

“…Contrary to our findings, Fransen et al found a lower CT uptake among non-western women (around 12%) [13]. The differences in results could probably be find in a different study design.…”

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 89%

Factors affecting the uptake of prenatal screening tests for congenital anomalies; a multicentre prospective cohort study

Wal

Verhoeven

Manniën

et al. 2014

“…It is likely that higher education implicates a higher ability to gain, interpret and use information on different health offers, health promotion or risk factors. Ethnicity in relation to uptake of prenatal diagnosis has been investigated in several previous studies [16–18]. A register-based study in the Netherlands shows that women with a North-African ethnic origin have the lowest participation rate in prenatal screening for Down’s syndrome, only 8% participation rate compared to the higher rate for women with a Dutch (28%) or other Western origin (33%) [16].…”

Section: Discussionmentioning

confidence: 99%

“…Ethnicity in relation to uptake of prenatal diagnosis has been investigated in several previous studies [16–18]. A register-based study in the Netherlands shows that women with a North-African ethnic origin have the lowest participation rate in prenatal screening for Down’s syndrome, only 8% participation rate compared to the higher rate for women with a Dutch (28%) or other Western origin (33%) [16]. Also, an Australian study demonstrates that ethnicity is strongly associated with the uptake of prenatal diagnosis [17].…”

Section: Discussionmentioning

confidence: 99%

Prenatal diagnosis in Sweden 2011 to 2013—a register-based study

Petersson

Lindkvist

Persson

et al. 2016

BackgroundPrenatal diagnosis involves methods used in early pregnancy as either screening tests or diagnostic methods. The aims of the study were to i) investigate guidelines on prenatal diagnosis in the counties of Sweden, ii) investigate uptake of prenatal diagnosis, and iii) background characteristics and pregnancy outcomes in relation to different prenatal diagnostic methods.MethodsA retrospective cross-sectional study using data from the Swedish Pregnancy Register 2011 to 2013 (284,789 pregnancies) was performed. Additionally, guidelines on prenatal diagnosis were collected. Biostatistical and epidemiological analyses were performed including calculation of odds ratios (OR) and their 95% confidence intervals in univariate and multivariate logistic regression analyses.ResultsThe national uptake of routine ultrasound examination, Combined Ultrasound and Biochemical test (CUB), Amniocentesis (AC) and Chorionic Villus Sampling (CVS) were 97.6, 33.0, 2.6 and 1.1%, respectively. From 2012, 6/21 counties offered CUB test to all pregnant women, nine counties at specific indications, and five counties did not offer CUB at all. Advanced maternal age demonstrated the highest impact on uptake of prenatal diagnosis. Further, university educational level in relation to lower educational level was associated with an increased likelihood of undergoing CUB (OR 2.30, 95% CI 2.26–2.35), AC (OR 1.54, 95% CI 1.46–1.63) and CVS (OR 2.68, 95% CI 2.44–2.93).ConclusionOffers of prenatal diagnosis varied considerably between counties resulting in unequal access to prenatal diagnosis for pregnant women. The intentions of the Swedish Health and Medical Services Act stating equal care for all, was thus not fulfilled.

“…Different roles are presented in this model; medical technical expert, advisor and teacher, and counselor in case of exploring values and supporting decision making. The MIMES model identified a number of factors that are relevant in test uptake decisions, including not only well-known factors such as age, parity, family life and personal experience, but also ‘identity markers’ such as ethnicity and religion [10-14]. It is acknowledged that the difficult questions that confront clients in decision-making may be influenced by their religious convictions [15-18].…”

Section: Introductionmentioning

confidence: 99%

Prenatal screening for congenital anomalies: exploring midwives’ perceptions of counseling clients with religious backgrounds

Wal

Manniën

Gitsels

et al. 2014

BackgroundIn the Netherlands, prenatal screening follows an opting in system and comprises two non-invasive tests: the combined test to screen for trisomy 21 at 12 weeks of gestation and the fetal anomaly scan to detect structural anomalies at 20 weeks. Midwives counsel about prenatal screening tests for congenital anomalies and they are increasingly having to counsel women from religious backgrounds beyond their experience. This study assessed midwives’ perceptions and practices regarding taking client’s religious backgrounds into account during counseling. As Islam is the commonest non-western religion, we were particularly interested in midwives’ knowledge of whether pregnancy termination is allowed in Islam.MethodsThis exploratory study is part of the DELIVER study, which evaluated primary care midwifery in the Netherlands between September 2009 and January 2011. A questionnaire was sent to all 108 midwives of the twenty practices participating in the study.ResultsOf 98 respondents (response rate 92%), 68 (69%) said they took account of the client’s religion. The two main reasons for not doing so were that religion was considered irrelevant in the decision-making process and that it should be up to clients to initiate such discussions. Midwives’ own religious backgrounds were independent of whether they paid attention to the clients’ religious backgrounds. Eighty midwives (82%) said they did not counsel Muslim women differently from other women. Although midwives with relatively many Muslim clients had more knowledge of Islamic attitudes to terminating pregnancy in general than midwives with relatively fewer Muslim clients, the specific knowledge of termination regarding trisomy 21 and other congenital anomalies was limited in both groups.ConclusionWhile many midwives took client’s religion into account, few knew much about Islamic beliefs on prenatal screening for congenital anomalies. Midwives identified a need for additional education. To meet the needs of the changing client population, counselors need more knowledge of religious opinions about the termination of pregnancy and the skills to approach religious issues with clients.